Purpose or Case Report: The incidence of retropharyngeal abscesses in america is rising, despite the widespread use of antibiotics for symptoms of sore throat, fever, neck stiffness and stridor. Retropharyngeal abscesses were often considered a disease exclusively in children, requiring early recognition and aggressive management to prevent its significant risks of morbidity and mortality. The high rate of mortality associated with retropharyngeal abscesses is owed to its associated with airway obstruction, mediastinitis, aspiration pneumonia, epidural abscess, jugular venous thrombosis, necrotizing fasciitis, sepsis and erosion into the carotid artery. Often times, medical management and surgical incision and drainage attempts are unsuccessful and result in persistent abscess or worsened complications.

We studied two children, ages 9 months and age 11, each with a retropharyngeal abscess refractory to medical care. Both cases were in extremis, with respiratory and cardiac compromise.
Methods & Materials: Each case was performed under CT guidance with general anesthesia . Localization was performed with judicious use of contrast material to localize and avoid neurovascular structures. Appropriate 20 gauge needles were utilized to access and aspirate the abscesses.
Results: The 11 year old patient was aspirated via a direct oral approach to the retropharyngeal space whereas the second patient was aspirated via a percutaneous retromandibular - parapharyngeal approach. Both aspirations yielded purulent material with positive cultures, 9 mo. - strep progenies and propionibacterium acnes, and 11 year old - step progenies. Both collections were partially drained percutaneously, with only the retropharyngeal abscess required additional surgical intervention.
Conclusions: Percutaneous aspiration of parapharyngeal and retropharygeal abscesses in children can be a useful adjunct to conventional surgical drainage in life threatening cases of head and neck infections, and can be curative when performed in conjunction with appropriate antibiotic regimens.